Academic Health Science Networks:Bold ideas. Dramatic results. Lasting change.A selection of case studies spanning our first licence

2

Adopting and spreading innovation - regionally and nationallyEngland’s 15 Academic Health Science Networks work both locally to drive innovation and transformation, and as a connected national collaborative to identify what works best so it can be adopted and spread across wide geographies - helping the NHS save money and improve patient outcomes.

We have enabled the spread of over 200 innovations throughout 11,000 locations. These have benefited 6 million people, created more than 500 jobs and have leveraged £330m investment to improve health and support the NHS, social care and industry innovators.

Throughout this booklet you will find a selection of case studies, which highlight some of our latest innovations. These have been developed and proven within one or more AHSNs and are currently being considered for adoption and spread across our Network. Developed by clinical and commercial

innovators, they all evidence the AHSNs’ unique roles in supporting the vision of the NHS Five Year Forward View: brokering connections across sectors, leveraging funding and providing targeted support to speed up the adoption and spread of new technologies to save NHS resources and improve lives for patients.

For more examples demonstrating the depth and breadth of our work and impacts visit the AHSN Atlas of Solutions at www.atlas.ahsnnetwork.com - this website currently features over 70 AHSN innovation case studies.

3

For £1 per dose PReCept could prevent 1,400 pre-term babies getting cerebral palsy every year

At a cost of £1 per dose of magnesium sulphate to mothers in pre-term labour, PReCePT is transforming lives by preventing cerebral palsy - avoiding a £1m cost to the system during the person’s lifetime.

4

PReCePT Reducing cerebral palsy through improving uptake of magnesium sulphate in pre-term deliveries

This cost-effective project has been co-designed with a wide range of stakeholders, including patients, clinicians and management.

PReCePT provides a supported quality improvement toolkit, information materials and practical tools and training to raise awareness of evidence-based practice regarding the use of magnesium sulphate (MgSO4). The toolkit supports staff when considering MgSO4 in eligible pregnancies.

PReCePT was independently evaluated by NIHR CLAHRC West and has since been refined to allow evaluation of the effectiveness of a supported versus a self-engaged implementation in a prospective comparison.

This project is currently being reviewed for adoption and spread across the AHSN Network, and, if adopted nationally, it is estimated would prevent 1,400 pre-term babies from having cerebral palsy each year.

Watch here: www.vimeo.com/231859640

From a non-clinical perspective, I hadn’t heard that you could do anything to prevent cerebral palsy. I came into it through the Academic Health Science Network. I just met the project lead to see if I could offer her any project support, but actually all the project materials and the collateral from the AHSN was there.

I didn’t really have to do anything because it was all there. From my perspective it was evidence-based, it was a good thing to do… so now we’re just rolling it out. For me it was just a no-brainer to do."

Member of staff, maternity unit

5

Prescribing errors in general practices are not common - but when they happen they are an expensive cause of safety incidents, illness, hospitalisation and even deaths. Errors happen for a number of reasons but main causes include ‘contraindications’ (different drugs used together), failure to take action on computer warnings, lack of monitoring and breakdown of safety systems.

General practice prescribing error rates are estimated to be 5%, with serious errors affecting 1 in 500 of all prescription items. “PINCER” (Pharmacist-led INformation technology intervention for reducing Clinically important ERrors) helps tackle these

issues, by supporting GP practices using software systems alongside root cause analysis to identify why mistakes happened.

In the region where it began 2.9m patient records have been searched and 21,636 instances of potentially hazardous prescribing have been identified using 11 prescribing indicators - it is estimated that approximately half of these needed an intervention to avoid harm, cases that could otherwise have been missed.

It has now been spread to other parts of the country and is currently having further detailed evaluation of the implementation to see whether PINCER leads to reduced hospital admissions and death.

6

Reducing harm and saving moneyScaling up a pharmacist-led information technology intervention (‘PINCER’)

PINCER is a really worthwhile intervention. It has led to complex reviews being carried out by GP’s facilitated by practice pharmacists, which will ultimately improve patient safety."

Medicines Management Team

Identified 21,636 instances of

potentially hazardous

prescribing across 2.9m patients

7

Non-Injectable Arterial Connector (NIC)Eradicating wrong route drug administration

NIC improves infection control helping avoid serious adverse events, which can result in amputation - an error reported every 2 weeks in the NHS

This simple medical device, developed by NHS clinicians and NHS Innovation Accelerator Fellow Dr Maryanne Mariyaselvam, stops medication being accidentally given into the arterial line used to monitor patients in ICUs and operating theatres. It prevents arterial line infections and blood spillages during sampling and protects both patients and staff.

A wrong-route drug administration error can cost from £57 for a near miss to over £10,000 in the most serious cases, which results in the patient needing an amputation.

A national survey showed a national incidence of around 9% for wrong route drug administration using arterial lines in ICUs, 28.5% of participating ICUs had reported incidents in the past five years. Using the NIC could eradicate this error from the NHS.

The innovation is one of the themes of the ITT and has won national patient safety and Association of Anesthetists awards.

As an NIA Fellow, Maryanne has increased the number of trusts using the NIC from five to 14 and is now building national and international momentum.

A health economic evaluation showed that the NIC is easier and quicker to use than standard connectors and that the NIC stays on the arterial line for the lifetime of the line (and does not have be changed with each blood sample). In equipment costs alone, using the NIC saves £285 per trust per year.

Use of the NIC is considered to be dominant in health economics terms, as it delivers improved patient outcomes at reduced cost."

Anna Crispe, Independent Health Economist

9

PneuXPneumonia PreventionSystem

This ventilation tube and cuff pressure monitor stops one ventilator-associated pneumonia (VAP), one of the leading causes of death in intensive care units (ICU).

The system saves lives and money: each VAP episode costs the NHS £10,000 to £20,000 and for the patient results in increased complications, length of mechanical ventilation, length of stay and antibiotic use. VAP affects up to 20,000 patients each year, around a third of whom will die.

With standard leaky ventilation tubes, the cause of VAP is where bacteria contaminated secretions from the mouth and stomach leak into the patient’s lungs, leading to the potentially fatal pneumonia.

The PneuX system - unlike standard tubes - prevents leakage of the bacteria-laden secretions and protects the patient’s lungs and prevents VAP. 50% of all antibiotics used in the ICU are for the treatment of VAP. Clinical studies using the PneuX have showed 0% colonisation, 0% VAP and 0% antibiotic use over a 14 month study.

An independent health economic evaluation by the University of Birmingham and the Royal College of Surgeons, based on an NHS England funded patient study at New Cross Hospital, showed that using the PneuX has a cost saving to the NHS of £718 for every patient introduce into the ICU.

Using PneuX saves the NHS £718 for every

patient

10

The PneuX system has already received international interest and is currently being introduced into all of the ICUs at Massachusetts General Hospital, Boston, USA.

We are hugely impressed with the direct benefits to patient safety through preventing avoidable harm and improving outcomes. We urge healthcare providers to ensure the system is adopted. From a patient’s perspective, this is an opportunity that cannot be ignored."

Trevor Fernandes, Co-chair, East of England Citizens’ Senate

11

ESCAPE-painImproving mobility and reducing pain

ESCAPE-pain is improving lives for over 3,000 people with chronic joint pain

I was having a lot of knee pain and my mobility wasn’t good, so I went to my GP as I thought I needed a knee replacement. I began the exercises which I thought were really simple at first - in fact too easy - but soon realised they were working and being simple, they were so easy to do.

After a few weeks on the programme, I noticed a huge improvement and I’m not even thinking about a knee replacement now. I’m not only far less tired from the pain but can walk so much better. I can do 10,000 steps a day without thinking about it."

Meir Kattan, participant

Chronic joint pain, or osteoarthritis, affects one in five people over 50, and one in two over 80. This condition is life-inhibiting and most cases are managed in the community with painkillers - which are unpopular with patients and potentially harmful. It is estimated that a day a week of GPs’ time (20%) is spent helping people manage their joint pain

ESCAPE-pain is a RightCare endorsed, NICE-approved group rehabilitation programme for people with chronic joint pain, that integrates educational self-management and coping strategies with an exercise regimen individualised for each participant. It helps people understand their condition and takes them through a progressive exercise programme so they learn how to cope with pain better. It involves supervised sessions with follow up support to continue progress. It can be delivered in leisure centres, community centres and even work places - away from clinical settings.

The evidence for this programme shows that people achieve a marked improvement in mobility and pain reduction, and are better able to achieve

the activities of everyday life. There is also a marked impact on mood based on anxiety and depression score improvements after the programme compared to before. It is less costly than usual care plans, and generates savings in both primary and secondary care.

Every £1 invested in delivering ESCAPE-pain gives £5.20 return from a healthcare financial perspective. (Source independent assessment of MSK interventions by Public Health England October 17).

The programme has been given £392,000 of National Lottery funding from Sport England to help reduce the number of inactive older adults.

Currently there are 36 active sites running the ESCAPE-pain programme across six AHSN patches in England. The programme also runs in Wales and the Republic of Ireland.

Watch here: www.vimeo.com/151535343

13

Emergency Laparotomy CollaborativeReduces mortality rates and improves patient care

This involves the spread and adoption of the evidence-based Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) bundle within NHS Trusts. The programme brings together dozens of staff across the Trust - from emergency departments, radiology, acute admission units, theatres, anaesthetics and intensive care - with collaborative learning events. It is active across 28 hospitals / 24 NHS trusts within three AHSN regions.

It seeks to improve standards of care for patients undergoing emergency laparotomy surgery, reduce mortality rates, complications and hospital length of stay, while encouraging a culture of collaboration and embedding quality improvement skills to ensure sustainability of change.

Emergency laparotomy is a major surgical procedure, with 30,000 - 50,000 performed annually in the UK. However, 14.9% of patients are reported to die within 30 days of surgery, Over 25% of patients remain in hospital for more than 20 days after surgery, costing the NHS over £200m a year.

14

Key outcomes achieved so far include:• A fall in the risk adjusted

mortality rate by 18% in just three months, and length of stay fell by 8.5% (1.5 days)

• Over 98% of patients (+4,000) who had an emergency laparotomy received at least one aspect of the care at a participating hospital between 1st October 2015 and 30th September 2016

• Consultant led care has improved by 14.5% meaning 4 out of 5 patients now have a senior surgeon and anaesthetist present in theatre

• A health economics analysis suggests every £1 spent will result in approximately £4.50 benefit to the wider health and social economy

It showed how we can improve and approach any obstacles/ problems in delivering the bundle of care and how to plan better to implement the ELC bundle."

Participating hospital partner

Risk adjusted mortality

rate fell by 18% in first

three months

UroLift® (prostatic urethral lift) Shows great potential for treatment of enlarged prostate

This cost-effective, short and non-invasive treatment is for the common condition of Benign Prostatic Hyperplasia (BPH) - where an enlarged prostate can affect men aged 50+.

Currently, men with moderate or severe symptoms are commonly offered a surgical procedure (transurethral resection of the prostate (TURP) or laser), which involves cutting away or removing

existing tissue. This can lead to permanent side effects affecting sexual function, and persistent complications, placing further demand on the patient and NHS.

There are 20,000 TURP procedures each year (average inpatient stay of three days) costing the NHS £54m. A further £109m is spent on complications that require more episodes of hospital care.

16

The UroLift treatment takes less than 30 minutes, can prevent lengthy unnecessary stays in hospital, and targets the problem area for patients with increased accuracy and improved healing. Evidence shows the impact on reduced length of hospital stay and waiting times, and improved theatre capacity:

NHS trusts that have adopted UroLift have demonstrated that each procedure has taken 25 minutes compared to up to 72 minutes using current treatment. Each patient has been treated as a day case, with no need for a hospital stay, and only one patient has required a follow-up appointment.

It has been estimated that adoption of Urolift in the originating region alone would save over £1.3m in post-surgery complication costs. Scaled nationally, these savings are expected to exceed £22m as a conservative calculation.

Watch here: youtu.be/crmrk4erkdM

Estimated to save more

than 1,500 bed days per year

in Wessex

UroLift is an important addition to our current treatment options. It offers a minimally invasive treatment for men who have failed or had side effects from medical treatment or don’t want the more invasive surgical options. The majority of my patients have been very happy with the outcome, and we have been helping to reduce the trust waiting list because the procedure is quick and does not require a bed."

Mr Mark Harris, Consultant Urologist, Southampton General Hospital

Serenity Integrated MentoringReducing crisis calls to police and ambulance services

This pioneering project integrates mental health care and policing - bringing together policing and healthcare skills to achieve a positive difference to the lives of patients with complex mental health needs and their families. Previously the local police force was struggling to manage a small number of repeat callers with complex mental health needs. This project has enabled services to work together, gathering feedback from service users who have been supported by SIM at every opportunity.

This is a truly original project with tremendous impact. Lives have been changed; not only for the service users but for their loved ones, their communities and for those who had previously managed their care. Their work is not only sustainable but scalable, so that many more people can be reached both in this country and overseas. The winners have challenged established perspectives and brought two very different, very traditional cultures together, healing minds and changing mindsets along the way. Both nursing and policing will evolve as a result."

Carol Kefford, Chief Nurse with Nuffield Health, Chair of Awards Panel

Results show the approach produces significant clinical improvements - crisis calls to the police and ambulance service reduce, and in most cases are almost completely eliminated.

Admissions to A&E for false or malicious reasons reduce significantly, abusive behaviour towards NHS staff falls and families of mental health service users feel more supported.

Health Economic Analysis demonstrates how basic operational costs to police, ambulance, ED and mental health settings of around £19,800 annually per patient were reduced through us of SIM by 92% within 2 years.

Watch here: www.vimeo.com/179883091

Winner of the HRH Prince of Wales

Award for Integrated Approaches to Care

19

47% of England's young people

covered by i-Thrive community of

practice

Mental illness represents a quarter of the nation’s overall burden of disease, affecting at least ten per cent of children aged five to 16 years. Yet despite the vast scale of this challenge, only one quarter of those with mental illness are receiving treatment. i-THRIVE is providing a systematic and population focussed approach to improving the targeting of interventions for children, young people and their families. This implementation of the THRIVE model increases the efficiency and enhances the effectiveness of clinical services so that we can deliver better outcomes to more children.”

Professor Peter Fonagy, Programme Director for the AHSN Integrated Mental Health Programme at UCLPartners, National Clinical Lead of Improving Access to Psychological Therapies for Children and Young People

20

i-Thrive is transforming the way mental health services are organised for children and adolescents - with AHSN support it has been spread to cover 47% of England’s young people.

The model incorporates a new way of delivering support services alongside shared decision making - so that children and young people have much greater control over their care, which is integrated along the pathway from prevention through to complex treatment.

i-THRIVE has been designed to enable delivery of services that move a step further on from integrated care towards delivery of a population health model for child mental health.

The i-THRIVE Community of Practice has grown significantly since its creation in October 2015. The Community of Practice was launched with the ten national accelerator sites and has now grown to 72 Clinical Commissioning Group areas (as at Oct 2017).

i-Thrive has been shown to reduce waiting times and improve the experience of care - by accurately assessing young people the first time they ask for help, and delivering the care that they need more quickly.

Watch here: youtu.be/t8MToMwxKqA

i-ThriveDelivers mental health support services for children and young people

21

Notes

22

Notes

23

#AHSNs

Contact Us:Email us at: info@ahsnnetwork.comVisit us at: www.ahsnnetwork.com

www.atlas.ahsnnetwork.com